Charged Up About Chargemaster Automation

Karen Minich-Pourshadi, for HealthLeaders Media , November 1, 2010

Revenue integrity strives to prevent risk reoccurrence and lessen its impact. As any doctor will tell you, it’s better to prevent illness than to treat it. To prevent problems, in this instance, you need to use technology to your advantage. You need to make process improvements such as teaching staff to use the technology you have more adeptly, creating and follow best practice rules and ensuring correct payment through proper pricing, charging, coding and documentation.

I’m not advocating an unnecessary spend—in reality automating your chargemaster is as vital to the health of your hospital as having great physicians and top-notch medical equipment. Just ask Doug Barry, vice president of revenue cycle and HIM for Glen Falls Hospital in Glen Falls, NY.

This 400-bed hospital, largest one situated between Albany, NY and Montreal, Canada, includes a main acute care hospital campus and 28 health care facilities and a service area that stretches across six, primarily rural, counties and 3,300 square miles. The breadth of their coverage area means that many of the services they provide do not generate enough revenue to pay for themselves—a situation to which many other facilities can relate. For Glen Falls Hospital, optimizing their revenue is critical, which is why in fall 2009 the facility decided to invest a six-figure sum into automated revenue integrity software.

When the market tanked, Glen Falls Hospital went through the same budgetary overhaul that many hospitals nationwide did, however, at the end of their process they had cut their highly skilled chargemaster person. Recognizing this error, they promoted from within but still needed to train this person and provide the tools to discern where their revenue was leaking. It was time to automate. After researching and talking with various vendors, they landed on Craneware, based in Atlanta, GA.

“We needed this software for continuity and consistency. For us it was the absence of the intellectual capital [that made us realize] we needed to automate this process,” says Barry. “It’s an area with a high volume of activity; you need to have a control point.”

Prior to taking the software live, Barry’s team trained on it. What they found? Along with improvements in their ability to efficiently price, charge and code for services, their reporting and data mining processes went from being a weeklong effort to three to four minutes.

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2 comments on "Charged Up About Chargemaster Automation"

Michael (11/1/2010 at 6:00 PM)
Couldn't agree more Jill. The software from Craneware is probably the best solution to automate how a Provider uncovers potential gaps in their CDM, however I'm not certain any Provider would use the software exclusively to add charges unless they've done their due diligence of the operation to determine the validity of what the software found. I believe the Craneware software also helps identify trends and revenue gaps by inspecting claims as well as the links between supply chain spend and reimbursement. In these cases - I suspect the software is only automating the process of finding the potential gaps and missing links. It's up to the Providers' Revenue Integrity team to resolve any issues and fix the gaps, but their job is now spent fixing and not trying to find needles in a haystack. Software is only as good as the sustainable process build around the solution.

Jill R (11/1/2010 at 2:53 PM)
Let me start off by saying Craneware is a great product and worthwhile investment, however, Providers need to use some discretion when adding charges that may be all-inclusive or perceived as unbundled. While it may appear that there is greater potential for reimbursement, indeed you may be increasing your potential for denials, thus unrealistically inflating your AR, and expected Reimbursement. One of the modules Craneware offers is a product that looks at charging patterns nationwide and tells you, for example "75% of providers who charged for X, also billed for Y and Z". While this may invaluable for those whose CDMs are lacking in the appropriate macros, others may just be padding their claims with non-payable charges and engaging (unwittingly) in non-compliant billing practices, putting themselves at risk possibly for fraud/abuse investigation. I would use a GREAT deal of caution with this product. Just because 75% of hospitals do it, does NOT mean they are doing it the RAC audits have proven. As with everything, buyer beware, if it sounds too good to be true, it probably is. I am in no way suggesting that it is better to leave money on the table, far from it, just that you use some common sense and in all things, do what is right.......that's why it's called Revenue INTEGRITY.




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